Preparing for Medicare can be a complicated task, but it is important to ensure you make the most of this healthcare program. Whether you are nearing retirement or just starting to explore your options, this checklist provides six essential tips to help you prepare for Medicare. By following these guidelines, you can navigate the process with confidence and make informed decisions about your healthcare coverage.
Understand Medicare Basics
Original Medicare, frequently shortened to Medicare, is a comprehensive program aimed at reducing healthcare costs for those 65 and over, or those with pre-determined disabilities. Medicare coverage, while important, can be confusing. It’s best to start thinking about your Medicare journey by familiarizing yourself with the basics of Medicare. There are four parts, each with a different role in your healthcare coverage.
Part A – covers inpatient hospital care, skilled nursing facilities, nursing home, hospice, and home health care.
Part B- Covers doctors’ appointments and other outpatient medical services such as ambulance services, clinical laboratory services, vaccinations, health screenings, and preventive services.
Part C- Also known as Medicare Advantage, Covers Part A and B, but is offered by private insurance companies, often with extra benefits.
Part D- Covers prescription drug costs.
As you learn the basics of Medicare coverage, it is important to note that there could potentially be instances where Original Medicare does not offer enough coverage, and supplemental coverage plans, called Medigap plans, will need to be added at an additional cost.
Plan Ahead and Know Enrollment Deadlines
Medicare has specific enrollment periods and missing them can result in penalties or delays in coverage. If you are aging into Medicare, be sure to calculate when your Initial enrollment period will be. The initial enrollment period will be a unique period for each Medicare beneficiary, as this period is focused on the months around your 65th birthday. This enrollment period begins three months before your 65th birthday, includes your birth month, and the three months after your birthday month. For example, if your 65th birthday is in June, your Initial Enrollment Period will last from March through September.
Once you are enrolled in Original Medicare or a Medicare Advantage plan, there will be two more enrollment periods to be aware of. First, the Annual Enrollment Period (AEP), which runs from October 15th to December 7th, allows those already enrolled in Medicare to make changes to their current plan, including switching from Original Medicare to Medicare Advantage, and vice-versa. The Open Enrollment Period, from January 1st to March 31st is also an important time to recognize, as you will be able to enroll into a Medicare plan if you missed enrolling within your initial enrollment period.
Compare Medicare Plans
Research and compare the available Medicare and Medicare Advantage plans in your area. Visit the official Medicare website or schedule a one-on-one appointment with a licensed Medicare Specialist to review all of your options. eternalHealth Medicare Specialists are ready to take your call and guide you through the process whenever you are ready!
As you begin to research the plans available to you, it’s important to look at a variety of different aspects to determine which plans are best for you. Compare costs, coverage, network of healthcare providers, and additional benefits offered by different plans. It may be helpful to set a budget and create a list of your trusted providers and specialists to ensure they will be covered by your plan of choice. For example, with an eternaHealth Medicare Advantage Plan, enjoy inflation-busting low to $0 monthly premiums and an ever-evolving network of doctors, hospitals, and specialists. Preparing these lists will help you select a plan that aligns with your needs and price point.
Understand Prescription Drug Coverage
If you require prescription medications, you may consider enrolling in a Medicare Part D plan to receive prescription drug coverage. Understanding how these plans work, including the formulary (list of covered drugs), costs, and any coverage restrictions is important to ensure that your necessary medications are included in the plan. A Medicare Part D plan will be an extra cost on top of your Part A and Part B premiums, at a cost of about $33 extra.
If you are considering a Medicare Advantage plan, it’s important to know that frequently, Part D benefits are built into the plan, and generally offer $0 copays on tier 1 and tier 2 prescriptions. This also means that most plans will have their own formulary, or list of covered drugs, so it is important to review this important document for each plan you are considering, to ensure your important prescriptions are covered.
Consider Medicare Advantage Plans
Original Medicare won’t cover services like routine dental, hearing, or vision exams, so if these things are important to your health and well-being, consider a Medicare Advantage Plan. Vision, hearing, and dental are typical extra benefits covered by Medicare Advantage plans, but frequently, plans offer much more. Fitness benefits, transportation, in home support, and OTC benefits are just a few more options that Medicare Advantage plans offer above and beyond what Original Medicare does.
Medicare Advantage Plans also frequently offer low to $0 monthly premiums, making it easy for you to fit one into your budget. Additionally, unlike Original Medicare, Medicare Advantage Plans put a limit on yearly out of pocket costs. With an eternalHealth plan, these out-of-pocket maximums can be as low as $4,500, and offers a sense of security from unexpected medical costs.
Seek Out the Experts
Navigating the complex system of Medicare can be overwhelming. Consider seeking guidance from professionals, such as a licensed Medicare Specialist, who will work with you through the process, guide you through the plans, and assist you in enrolling. eternalHealth has a team waiting for you whenever you are ready, so give us a call at 1 (800) 831-9218 (TTY 711) to be connected to one of our friendly and knowledgeable specialists! These experts can provide personalized advice and help you make well-informed decisions based on your unique lifestyle.
Preparing for Medicare involves understanding its components, knowing your options, and evaluating your healthcare needs. By following these essential tips, you can approach the process with confidence and ensure you make the most of your Medicare coverage. Remember, being well-informed and proactive is key to securing the healthcare benefits you deserve. For more information on eternalHealth Medicare Advantage Plans, contact us at 1 (800) 831-9218 (TTY 711) or visit us online to download a FREE and helpful Medicare booklet at www.eternalHealth.com/AgingIn.